NPIMap

Organization Active NPI

Cookeville SNF Healthcare LLC

  • Skilled Nursing Facility
  • Cookeville, TN
National Provider Identifier
1497582894
Registry record updated Sep 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
COOKEVILLE SNF HEALTHCARE LLC
Practice address
444 One Eleven PL
Cookeville, TN 38506-4358
Phone
(931) 525-6655
NPI assigned
Sep 18, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
John Mitchell
Title
Secretary
Phone
(385) 988-3319

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

444 One Eleven PL
Cookeville, TN 38506-4358

Mailing address

262 N University Ave
Farmington, UT 84025-2975

Other names 1

  • GRANDVIEW POST ACUTE Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20260324003197 TN Part A Provider - Skilled Nursing Facility 9436633757

Skilled nursing facility certification: CCN 445427

Legal name
COOKEVILLE SNF HEALTHCARE LLC
Doing business as
GRANDVIEW POST ACUTE
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jul 13, 2001
Last certification
Mar 31, 2022
Beds
120
Ownership / control type
Corporation
Multi-facility organization
PACS Group
Organization structure
LLCProprietary
Enrollment address
444 One Eleven PL
Cookeville, TN 38506-4358
Nursing home name
GRANDVIEW POST ACUTE
Affiliated entity
PACS GROUP

Care Compare: Nursing home

Medicare Care Compare
Listed as
Grandview Post AcuteCCN 445427
Overall star rating
1 of 5
Health inspections
1 of 5
Staffing
2 of 5
Quality measures
1 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Jul 13, 2001
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
12090.6 residents per day on average
Chain
Pacs Group274 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
44D0992200Cookeville SNF Healthcare LLC444 One Eleven Place, Cookeville, TN 38506Certificate of waiverOct 9, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 19

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Amber Bertram Individual Managing Control - Governing BodyDirector of Nursing Jan 1, 2025
Branch Banking & Trust Company Organization, Charlotte, NC Corporation, Financial institution, For-profit, Owned by another organization or individual 5% Or Greater Security Interest Jan 1, 2025 100%
Pacs Holdings, LLC Organization, Farmington, UT LLC, Holding company, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Jan 1, 2025 100%
Jason H Murray Individual 5% Or Greater Indirect Ownership InterestDirector - Pacs Group, Inc Jan 1, 2025 35.2%
John T Mitchell Individual Corporate OfficerSecretary Jan 1, 2025
Edna L Wade Individual Managing Control - Governing BodyDietary Director Jan 1, 2025
John N Bell Individual Managing Control - Governing BodyMaintenance Director Jan 1, 2025
Frederick G Apt Individual Corporate OfficerTreasurer Jan 1, 2025
444 One Eleven Place TN, LLC Organization, New York, NY LLC, For-profit Operational/Managerial Control Jan 1, 2025
Adp of the SNF Apr 7, 2025
Providence Group NH, LLC Organization, Farmington, UT LLC, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Jan 1, 2025 100%
Organization, New York, NY LLC, For-profit Adp of the SNF Jan 1, 2025
Providence Administrative Consulting Services Inc Organization, Farmington, UT Corporation, Consulting firm Adp of the SNF Jan 22, 2025
Joshua O Jergensen Individual Corporate OfficerPresident Jan 1, 2025
Michael T Cox Individual Operational/Managerial Control Jan 1, 2025
Managing Control - Governing BodyMedical Director Jan 1, 2025
Adp of the SNF Mar 2, 2026
Pacs Group, Inc. Organization, Farmington, UT Corporation, Holding company, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Jan 1, 2025 100%
Uriah Bowman Individual Operational/Managerial Control Jan 1, 2025
Managing Control - Governing BodySNF Administrator Jan 1, 2025
Adp of the SNF Mar 2, 2026
Alivia B Sparks Individual Managing Control - Governing BodyDirector of Rehabilitation Jan 1, 2025
Truist Bank Organization, Charlotte, NC Financial institution, For-profit, Owned by another organization or individual 5% Or Greater Security Interest Jan 1, 2025 100%
Mark D Hancock Individual 5% Or Greater Indirect Ownership InterestDirector - Pacs Group, Inc Jan 1, 2025 35.2%

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 186

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 186

Practitioners & affiliated clinicians

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1726617600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726617600000",
    "number": "1497582894",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "262 N UNIVERSITY AVE",
            "city": "FARMINGTON",
            "state": "UT",
            "postal_code": "840252975"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "444 ONE ELEVEN PL",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "385064358",
            "telephone_number": "931-525-6655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COOKEVILLE SNF HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-09-18",
        "last_updated": "2024-09-18",
        "certification_date": "2024-09-18",
        "status": "A",
        "authorized_official_last_name": "MITCHELL",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "385-988-3319"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GRANDVIEW POST ACUTE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cookeville, TN

Sources for this page

Verify at the official NPI Registry.